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Aucoin M, LaChance L, van der Wurff I, McLaren M, Monteiro S, Miller S, Jenkins A, Sabri E, Cooley K. Dietary counseling plus omega-3 supplementation in the treatment of generalized anxiety disorder: results of a randomized wait-list controlled pilot trial (the 'EASe-GAD Trial'). Nutr Neurosci 2025; 28:635-648. [PMID: 39316026 DOI: 10.1080/1028415x.2024.2403901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
OBJECTIVES Clinical evidence suggests that nutrition interventions can significantly improve symptoms of major depressive disorder; however, the effect on clinical anxiety symptoms in individuals with anxiety disorders has not been studied. The primary objective of the present study was to assess the feasibility and acceptability of a nutrition intervention. The secondary objectives included assessing changes in anxiety symptom severity, diet quality, self-efficacy, mindful eating, quality of life, and biomarkers. METHODS This study was a randomized, wait-list controlled pilot trial delivering a 12-week, biweekly dietary counseling intervention and omega-3 supplementation to 50 adult women with generalized anxiety disorder. Questionnaires and blood work were completed at baseline, after the waiting period, and after the intervention. RESULTS 443 individuals expressed interest within eight months; 50 met the criteria for enrollment. The mean number of sessions attended was 6.4. Final questionnaires were completed by 46 participants. Eighty-four percent of participants strongly agreed with the statement 'My experience during this study was positive'. The mean anxiety symptom severity score in the intervention group was 26.2 (95% CI 22.94-29.48) at baseline and 11.0 (95% CI 8.05-13.87) at week 12. The mean diet quality score was 7.2 (95% CI 6.32-8.10) and 10.5 (95% CI 9.55-11.49) at baseline and week 12, respectively. Among the waitlist participants, the mean baseline anxiety score was 29.3 (95% CI 24.73-33.91) and 26.8 (95% CI 22.09-31.56) at week 12. DISCUSSION This study was feasible and acceptable. Participation in the intervention was associated with a decrease in anxiety symptoms. These findings lay the foundation for large-scale studies. Trial registration: ClinicalTrials.gov NCT05573672.
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Affiliation(s)
- Monique Aucoin
- Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada
- Human Health and Nutritional Sciences, University of Guelph, Guelph, Canada
| | - Laura LaChance
- Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
- Department of Psychiatry, St. Mary's Hospital, Montreal, Canada
| | - Inge van der Wurff
- Health Psychology, Faculty of Psychology, Open University of the Netherlands, Heerlen, The Netherlands
| | - Meagan McLaren
- Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada
| | - Sasha Monteiro
- Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada
| | | | | | - Elham Sabri
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Kieran Cooley
- Research and Clinical Epidemiology, Canadian College of Naturopathic Medicine, Toronto, Canada
- Southern Cross University, Lismore, Australia
- University of Technology Sydney, Sydney, Australia
- Human Biology, University of Toronto, Toronto, Canada
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Tabara MF. Addressing social function in the treatment of depression: A call for holistic approaches. World J Psychiatry 2025; 15:102658. [PMID: 39974494 PMCID: PMC11758034 DOI: 10.5498/wjp.v15.i2.102658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2024] [Revised: 11/30/2024] [Accepted: 12/19/2024] [Indexed: 01/14/2025] Open
Abstract
This article discusses the importance of addressing social functioning impairment in patients with residual depressive symptoms, as highlighted in the study by Liao et al. The authors showed that social dysfunction persists in many patients despite symptom remission. This observation calls for a shift in depression treatment strategies, with an emphasis on integrating social functioning as a key treatment goal. This article suggests targeted interventions that focus on both symptomatic relief and the restoration of social function.
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Affiliation(s)
- Muhammed Fatih Tabara
- Department of Psychiatry, Firat University School of Medicine, Elazig 23200, Türkiye
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Sutliffe JT, Lopez NV, Papini NM, Herrmann SD. Examining Real-World Evidence of Depression-Related Symptom Reduction Through a Comprehensive Holistic Lifestyle Intervention. Am J Lifestyle Med 2024:15598276241280883. [PMID: 39554956 PMCID: PMC11562381 DOI: 10.1177/15598276241280883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2024] Open
Abstract
Depression is a global health concern, with various treatments available. In this study, participants (n = 430) were self-selected or medically referred to a residential lifestyle program at the Black Hills Health & Education Center (BHHEC), with a mean stay of 19 days. Individualized treatment plans included structured physical activity sessions, counseling sessions, and the provision of a vegan diet. Beck Depression Inventory-II, self-reported total exercise minutes, resistance exercise minutes, and sleep, along with the number of holistic treatments and counseling sessions, were evaluated. Paired samples t-tests indicated a significant decrease in depression scores over time (MT1 = 20.14, MT2 = 6.17, P < .001). Results from the multiple linear regression that evaluated total exercise minutes, resistance exercise, number of treatments and counseling sessions, and average reported hours of nightly sleep on depression scores at time 2 indicated that average reported hours of nightly sleep were the only significant predictor of depression scores at time 2 (P < .05). While depression scores significantly improved from baseline to post-assessment for all participants, it is possible that an unmeasured variable, or the synergistic intervention effect of the wellness program, accounted for changes in depressive symptoms over time. Future studies should incorporate sleep quality and assessing time spent in nature to explore these relationships further.
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Affiliation(s)
- Jay T. Sutliffe
- Department of Health Sciences, PRANDIAL Lab, Northern Arizona University, Flagstaff, AZ, USA
| | - Nanette V. Lopez
- Department of Health Sciences, PRANDIAL Lab, Northern Arizona University, Flagstaff, AZ, USA
| | - Natalie M. Papini
- Department of Health Sciences, PRANDIAL Lab, Northern Arizona University, Flagstaff, AZ, USA
| | - Stephen D. Herrmann
- Internal Medicine Department, University of Kansas Medical Center, Kansas City, KS, USA
- Kansas Center for Metabolism and Obesity Research, University of Kansas Medical Center, Kansas City, KS, USA
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Aucoin M, LaChance L, van der Wurff I, Miller S, Naidoo U, Jenkins A, Cooley K. Dietary counselling plus omega-3 supplementation in the treatment of generalized anxiety disorder: protocol for a randomized wait-list controlled pilot trial (the "EASe-GAD Trial"). Pilot Feasibility Stud 2023; 9:186. [PMID: 37950301 PMCID: PMC10636887 DOI: 10.1186/s40814-023-01414-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Anxiety disorders are prevalent and disabling conditions involving excessive worry and tension. Generalized anxiety disorder (GAD), the most common anxiety disorder, affects 5% of individuals from high-income countries and many individuals report that treatment options are not accessible, effective, or tolerable. Clinical evidence suggests that nutrition interventions, based on the Mediterranean diet and supplementation of omega-3 fatty acids, can significantly improve symptoms of depression; however, the effect of nutrition interventions on anxiety symptoms has not been studied in a clinical population. The primary objective of the present study is to assess the feasibility and acceptability of a dietary counselling and omega-3 fatty acid supplementation intervention delivered to adult women with GAD. The secondary objectives include assessing changes in anxiety symptom severity, assessing changes in quality of life, assessing changes in biomarkers, and evaluating the components of the program. METHODS This study is a randomized, wait-list controlled pilot trial delivering a 12-week, dietary counselling intervention and omega-3 supplementation to 50 adult women with GAD. Participants will complete seven individual counselling sessions which include education, personalized recommendations, mindful eating techniques, motivational interviewing, and goal setting. They will be provided with recipes, instructional videos, and food items. The intervention is designed based on the Social Cognitive Theory and previous research that has been done by the author team to identify dietary constituents with the most evidence to support their use in the treatment of anxiety disorders. Questionnaires and blood work will be completed at baseline, after the waiting period (for those in the waitlist group), and after the intervention. DISCUSSION Results from this study will lay the foundation for future large-scale studies in this area and may provide preliminary evidence of the role of diet counselling and omega-3 supplementation in the management of GAD. Research on the role of nutrition in psychiatric care has been identified as a priority by a number of international organizations. The present trial directly addresses the call for the research that is most needed to advance the field. TRIAL REGISTRATION This protocol was registered at ClinicalTrials.gov on October 10, 2022; NCT05573672 . Trial sponsor: The Canadian College of Naturopathic Medicine, 1255 Sheppard Ave E, Toronto, ON M2K 1E2, 416-498-1255. Steering committee: Composed of MA, LL, KC, IvdW, SM, UN, AJ. The committee meets monthly to oversee the trial. Protocol identifier: CCNM_EASe-GADCT_2201v4.
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Affiliation(s)
- Monique Aucoin
- Canadian College of Naturopathic Medicine, Toronto, Canada.
- University of Guelph, Guelph, Canada.
| | - Laura LaChance
- McGill University, Montreal, Canada
- St. Mary's Hospital, Montreal, Canada
| | - Inge van der Wurff
- Health Psychology, Faculty of Psychology, Open University of the Netherlands, Utrecht, Netherlands
| | | | - Umadevi Naidoo
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, USA
| | | | - Kieran Cooley
- Canadian College of Naturopathic Medicine, Toronto, Canada
- Southern Cross University, Lismore, Australia
- University of Technology Sydney, Ultimo, Australia
- Pacific College of Health and Science, San Diego, USA
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Aguilar-Latorre A, Oliván-Blázquez B, Algorta GP, Serrano-Ripoll MJ, Escobar-Olszewski L, Turón-Lanuza A. One-year follow-up of the effectiveness of a lifestyle modification programme as an adjuvant treatment of depression in primary care: A randomised clinical trial. J Affect Disord 2023; 332:231-237. [PMID: 37054898 DOI: 10.1016/j.jad.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 03/20/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND An estimated 280 million individuals suffer from depression. Brief group interventions in Primary Healthcare Centres (PHCs) are recommended. One goal of these interventions is to educate people about healthy lifestyle habits, as they prevent the development of depression. This study aims to analyse the one-year follow-up results about the effectiveness of a Lifestyle Modification Programme (LMP) and an LMP plus Information and Communication Technologies (LMP + ICTs) when compared to Treatment as Usual (TAU). METHODS We conducted an open-label, multicentre, pragmatic, randomised clinical trial. A total of 188 individuals that visited a general practitioner and met the inclusion criteria were randomised. LMP consisted of six weekly 90-minute group sessions focusing on lifestyle improvement. LMP + ICTs was a hybrid of the LMP format with the inclusion of a wearable smartwatch. We used linear mixed models (with a random intercept and an unstructured covariance) to evaluate the effectiveness of the interventions, and an intention-to-treat analysis and Multiple Imputation technique for handling missing data. RESULTS LMP + ICTs showed a statistically significant reduction on depressive symptoms (b = -2.68, 95 % CI = [-4.239, -1.133] p = .001) and sedentarism (b = -37.38, 95 % CI [-62.930, -11.833], p = .004) compared to TAU. LIMITATIONS Most of the dropouts were due to time restrictions. CONCLUSIONS In long-term, LMPs plus ICTs administered in PHCs to people suffering from depression were effective in reducing depressive symptomatology and sedentarism comparing to TAU. More research is needed to enhance adherence to lifestyle recommendations. These promising programmes could be easily implemented in PHCs. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03951350).
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Affiliation(s)
- Alejandra Aguilar-Latorre
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Oliván-Blázquez
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain; Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain.
| | - Guillermo Pérez Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | - Maria J Serrano-Ripoll
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, Palma, Balearic Islands, Spain; Research in Preventive Activities and Promotion and in Cancer Illes Balears (GRAPP-CAIB), Health Research Institute of the Balearic Islands (IdISBa), Palma, Balearic Islands, Spain; Research Netork in Preventive Activities and Health Promotion (RedIAPP), Barcelona, Spain
| | - Linda Escobar-Olszewski
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles, United States of America
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Garcia-Toro M, Aguilar-Latorre A, Garcia A, Navarro-Guzmán C, Gervilla E, Seguí A, Gazquez F, Marino JA, Gomez-Juanes R, Serrano-Ripoll MJ, Oliván-Blázquez B, Garcia-Campayo J, Maloney S, Montero-Marin J. Mindfulness skills and experiential avoidance as therapeutic mechanisms for treatment-resistant depression through mindfulness-based cognitive therapy and lifestyle modification. Front Psychol 2023; 14:1008891. [PMID: 36968708 PMCID: PMC10033944 DOI: 10.3389/fpsyg.2023.1008891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 02/15/2023] [Indexed: 03/11/2023] Open
Abstract
Background/objectiveThe COVID-19 pandemic and consequent physical distancing has made it difficult to provide care for those with Treatment-Resistant Depression (TRD). As a secondary analysis of a clinical trial, the aim of this study was to explore potential mechanisms through which three online-delivered approaches, added to treatment as usual, improve depressive symptoms in TRD patients.MethodsThe three approaches included (a) Minimal Lifestyle Intervention (MLI), (b) Mindfulness-Based Cognitive Therapy (MBCT), and (c) Lifestyle Modification Program (LMP). Sixty-six participants with TRD completed assessments pre-post intervention (mindfulness skills [FFMQ]; self-compassion [SCS]; and experiential avoidance [AAQ-II]) and pre-intervention to follow-up (depressive symptoms [BDI-II]). Data were analyzed using within-subjects regression models to test mediation.ResultsMindfulness skills mediated the effect of MBCT on depressive symptoms (ab = −4.69, 95% CI = −12.93 to−0.32), whereas the lack of experiential avoidance mediated the effect of LMP on depressive symptoms (ab = −3.22, 95% CI = −7.03 to−0.14).ConclusionStrengthening mindfulness skills and decreasing experiential avoidance may promote recovery in patients with TRD, MBCT, and LMP have demonstrated that they may help increase mindfulness skills and decrease experiential avoidance, respectively. Future work will need to unpick the components of these interventions to help isolate active ingredients and increase optimization.
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Affiliation(s)
- Mauro Garcia-Toro
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Department of Medicine, University of the Balearic Islands, Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
| | - Alejandra Aguilar-Latorre
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- *Correspondence: Alejandra Aguilar-Latorre,
| | - Aurora Garcia
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | | | - Elena Gervilla
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Department of Psychology, University of the Balearic Islands, Palma, Spain
| | - Andrea Seguí
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Francisco Gazquez
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Jose Antonio Marino
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - Rocío Gomez-Juanes
- University Institute of Health Science Research (IUNICS), University of the Balearic Islands, Palma, Spain
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
| | - María J. Serrano-Ripoll
- Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
| | - Bárbara Oliván-Blázquez
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Javier Garcia-Campayo
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Carlos III Health Institute, Madrid, Spain
- Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | - Shannon Maloney
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
| | - Jesús Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom
- Teaching, Research and Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBER Epidemiology and Public Health-CIBERESP), Madrid, Spain
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Garcia A, Yáñez AM, Bennasar-Veny M, Navarro C, Salva J, Ibarra O, Gomez-Juanes R, Serrano-Ripoll MJ, Oliván B, Gili M, Roca M, Riera-Serra P, Aguilar-Latorre A, Montero-Marin J, Garcia-Toro M. Efficacy of an adjuvant non-face-to-face multimodal lifestyle modification program for patients with treatment-resistant major depression: A randomized controlled trial. Psychiatry Res 2023; 319:114975. [PMID: 36442318 DOI: 10.1016/j.psychres.2022.114975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The high prevalence of depression is partly attributable to the poor response of patients to first-line antidepressants. Multimodal programs that promote a healthy lifestyle are successful in treating depression when used as a complementary therapy, but their medium- and long-term benefits have not been demonstrated for patients with treatment-resistant depression (TRD). The main aim of this study was to compare the effectiveness of a lifestyle modification program (LMP) with mindfulness-based cognitive therapy (MBCT) and a placebo-control (written suggestions for lifestyle changes) in Spanish patients with TRD. METHODS This controlled clinical trial randomized 94 patients with TRD into 3 arms. The primary outcome was the Beck Depression Inventory-II (BDI-II) score at baseline, 2, 6 and 12 months. The secondary outcomes were changes in scores that evaluated quality-of-life, adherence to the Mediterranean diet, physical activity, and social support. RESULTS Relative to the placebo group, the LMP and MBCT groups had significantly better quality of life (p = 0.017; p = 0.027), and the LMP group had significantly better adherence to the Mediterranean diet (p<0.001) and reduced use of antidepressants (p = 0.036). However, the three groups showed no significant differences in BDI-II score. LIMITATIONS Only about half of the planned 180 patients were recruited, in part due to the COVID-19 pandemic. CONCLUSIONS There was no evidence that the LMP treatment significantly reduced symptoms of depression relative to the other groups during the COVID-19 lockdown.
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Affiliation(s)
- Aurora Garcia
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain
| | - Aina M Yáñez
- Health Research Institute of the Balearic Islands (IdISBa), Spain; Department of Nursing and Physiotherapy and Research Group on Global Health and Human Development, UIB
| | - Miquel Bennasar-Veny
- Health Research Institute of the Balearic Islands (IdISBa), Spain; Department of Nursing and Physiotherapy and Research Group on Global Health and Human Development, UIB; CIBER de Epidemiologíública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain.
| | - Capilla Navarro
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain
| | - Joan Salva
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain; Department of Medicine, University of the Balearic Islands, E-07122 Palma, Spain
| | - Olga Ibarra
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain
| | - Rocío Gomez-Juanes
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain; Department of Medicine, University of the Balearic Islands, E-07122 Palma, Spain
| | - María J Serrano-Ripoll
- Primary Care Research Unit of Majorca, Balearic Islands Health Services and Department of Psychology, UIB
| | - Bárbara Oliván
- Department of Psychology and Sociology, University of Zaragoza. Primary Care Prevention and Health Promotion Research Network (RedIAPP), Zaragoza, Spain
| | - Margalida Gili
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain
| | - Miquel Roca
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain; Department of Medicine, University of the Balearic Islands, E-07122 Palma, Spain
| | - Pau Riera-Serra
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain
| | | | - Jesús Montero-Marin
- Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Teaching, Research & Innovation Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
| | - Mauro Garcia-Toro
- Health Research Institute of the Balearic Islands (IdISBa), Spain; University Institute of Health Science Research (IUNICS), University of the Balearic Islands (UIB), Spain; Department of Medicine, University of the Balearic Islands, E-07122 Palma, Spain
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Aguilar-Latorre A, Pérez Algorta G, Navarro-Guzmán C, Serrano-Ripoll MJ, Oliván-Blázquez B. Effectiveness of a lifestyle modification programme in the treatment of depression symptoms in primary care. Front Med (Lausanne) 2022; 9:954644. [PMID: 35957845 PMCID: PMC9361711 DOI: 10.3389/fmed.2022.954644] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 07/07/2022] [Indexed: 11/19/2022] Open
Abstract
Background Depression symptoms are prevalent in the general population, and their onset and continuation may be related to biological and psychosocial factors, many of which are related to lifestyle aspects. Health promotion and lifestyle modification programmes (LMPs) may be effective on reducing the symptoms. The objective of this study was to analyse the clinical effectiveness of a LMP and a LMP plus Information and Communication Technologies, when compared to Treatment as Usual (TAU) over 6 months. The interventions were offered as an adjuvant treatment delivered in Primary Healthcare Centers (PHCs) for people with depression symptoms. Methods We conducted an open-label, multicentre, pragmatic, randomized clinical trial. Participants were recruited from several PHCs. Those participants visiting general practitioner for any reason, who also met the inclusion criteria (scoring 10 to 30 points on the Beck II Self-Applied Depression Inventory) were invited to take part in the study. TAU+LMP consisted of six weekly 90-min group sessions focused on improving lifestyle. TAU+LMP + ICTs replicated the TAU+LMP format, plus the addition of a wearable smartwatch to measure daily minutes walked and sleep patterns. A total of 188 participants consented to participate in the study and were randomized. We used linear mixed models, with a random intercept and an unstructured covariance to evaluate the impact of the interventions compared to TAU. Results Both interventions showed a statistically significant reduction on depressive symptoms compared to TAU (TAU+LMP vs. TAU slope difference, b = −3.38, 95% CI= [−5.286, −1.474] p = 0.001 and TAU+LMP+ICTs vs. TAU slope difference, b = −4.05, 95% CI = [−5.919, −2.197], p < 0.001). These reductions imply a moderate effect size. In the TAU+LMP+ICTs there was a significant increase regarding minutes walking per week (b = 99.77) and adherence to Mediterranean diet (b = 0.702). In the TAU+LMP there was a significant decrease regarding bad sleep quality (b = −1.24). Conclusion TAU+LMPs administered in PHCs to people experiencing depression symptoms were effective on reducing these symptoms compared to TAU. They also have a positive impact on changing several lifestyle factors. These findings indicate that these interventions can be promising strategies for PHCs.
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Affiliation(s)
- Alejandra Aguilar-Latorre
- Primary Healthcare Center Arrabal, Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Guillermo Pérez Algorta
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, United Kingdom
| | | | - María J. Serrano-Ripoll
- Primary Care Research Unit of Mallorca, Balearic Islands Health Services, Palma, Spain
- Research in Preventive Activities and Promotion and in Cancer Illes Balears (GRAPP-CAIB), Balearic Islands Health Research Institute (IdISBa), Palma, Spain
- Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
- *Correspondence: María J. Serrano-Ripoll
| | - Bárbara Oliván-Blázquez
- Primary Healthcare Center Arrabal, Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
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Ip AKY, Ho FYY, Yeung WF, Chung KF, Ng CH, Oliver G, Sarris J. Effects of a group-based lifestyle medicine for depression: A pilot randomized controlled trial. PLoS One 2021; 16:e0258059. [PMID: 34624047 PMCID: PMC8500430 DOI: 10.1371/journal.pone.0258059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 09/14/2021] [Indexed: 11/19/2022] Open
Abstract
Given the growing evidence that a range of lifestyle factors are involved in the etiology of depression, a ‘lifestyle medicine’ approach can be potentially safe and cost-effective to prevent or treat depression. To examine the effects and acceptability of a group-based, integrative lifestyle medicine intervention as a standalone treatment for managing depressive symptoms, a pilot randomized controlled trial (RCT) was conducted in a Chinese adult population in 2018. Participants (n = 31) with PHQ-9 score above the cut-off of ≥ 10, which was indicative of moderate to severe depression, were recruited from the general community in Hong Kong and randomly assigned to lifestyle medicine group (LM group) or care-as-usual group (CAU group) in a ratio of 1:1. Participants in the LM group received 2-hour group sessions once per week for six consecutive weeks, which covered diet, exercise, mindfulness, psychoeducation, and sleep management. Linear mixed-effects model analyses showed that the LM group had a significant reduction in PHQ-9 scores compared to the CAU group at immediate posttreatment and 12-week posttreatment follow-up (d = 0.69 and 0.73, respectively). Moreover, there were significantly greater improvements in anxiety, stress, and insomnia symptoms (measured by DASS-21 and ISI) at all time points in the LM group (d = 0.42–1.16). The results suggests that our 6-week group-based, integrative lifestyle intervention program is effective in lowering depressive, anxiety, stress, and insomnia symptoms in the Chinese population. Further studies in clinical populations with a larger sample size and longer follow-up are warranted.
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Affiliation(s)
- Agnes Ka-Yan Ip
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
| | - Fiona Yan-Yee Ho
- Department of Psychology, The Chinese University of Hong Kong, Shatin, Hong Kong
- * E-mail:
| | - Wing-Fai Yeung
- School of Nursing, The Hong Kong Polytechnic University, Hunghom, Hong Kong
| | - Ka-Fai Chung
- Department of Psychiatry, The University of Hong Kong, Pokfulam, Hong Kong
| | - Chee H. Ng
- Department of Psychiatry, Professorial Unit, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Oliver
- Department of Psychiatry, Professorial Unit, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jerome Sarris
- Department of Psychiatry, Professorial Unit, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
- Western Sydney University, NICM Heath Research Institute, Westmead, NSW, Australia
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10
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Cherian L, Wang Y, Holland T, Agarwal P, Aggarwal N, Morris MC. DASH and Mediterranean-Dash Intervention for Neurodegenerative Delay (MIND) Diets Are Associated With Fewer Depressive Symptoms Over Time. J Gerontol A Biol Sci Med Sci 2021; 76:151-156. [PMID: 32080745 DOI: 10.1093/gerona/glaa044] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Depression is common in older adults and more prevalent in those with cognitive impairment, vascular risk factors, or stroke. Nonpharmacologic strategies to reduce depression, such as diet, may be effective; however, few studies have investigated the relation. METHODS A total of 709 participants (23.3% men, mean age 80.4), from an observational prospective cohort study were assessed annually for an average of 6.53 years of follow-up. Participants with missing or invalid baseline dietary evaluations or fewer than two depression assessments were excluded. Depressive symptoms were assessed with a 10-item version of the Center for Epidemiologic Studies Depression scale. High burden of depressive symptoms was defined as the presence of four or more depressive symptoms. Diet scores were computed using a validated food frequency questionnaire for the Dietary Approaches to Stop Hypertension (DASH) diet, Mediterranean diet, Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND) diet, and Western diets. Diet scores were modeled in tertiles. A generalized estimating equation (GEE) model was performed for the longitudinal analysis of depression as a binary outcome. RESULTS Participants in the highest tertile of the DASH (β = -0.10, confidence interval [CI]: -0.20, -0.0064) and MIND (β = -0.12, CI: -0.23, -0.0092) diet scores had lower rates of depressive symptoms over time when compared to those in the respective lowest tertiles. The Western diet was positively associated with depressive symptoms over time (β = 0.093, p-trend = .05). CONCLUSIONS Diet may be effective in reducing depressive symptoms in older adults. A diet intervention trial may be needed to determine the optimal nutritional components for prevention of late onset depression.
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Affiliation(s)
- Laurel Cherian
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois
| | - Yamin Wang
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Thomas Holland
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Puja Agarwal
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Neelum Aggarwal
- Department of Neurological Sciences, Rush University Medical Center, Chicago, Illinois.,Rush Alzheimer's Disease Center, Chicago, Illinois
| | - Martha Clare Morris
- Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
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11
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Galbally M, Watson SJ, Boyce P, Anglin R, McKinnon E, Lewis AJ. Maternal diet, depression and antidepressant treatment in pregnancy and across the first 12 months postpartum in the MPEWS pregnancy cohort study: Perinatal diet, depression and antidepressant use. J Affect Disord 2021; 288:74-82. [PMID: 33845327 DOI: 10.1016/j.jad.2021.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/06/2021] [Accepted: 03/17/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is increasing interest in the association between perinatal depression and diet including whether diet may have an impact on depressive symptoms and equally whether depression influences diet. Furthermore, whether pharmacological treatment of depression with antidepressant medication also may influence diet. METHODS We examine diet, perinatal depression, and antidepressant use in 442 women recruited in early pregnancy and followed until 12 months postpartum as part of the Mercy Pregnancy Emotional Wellbeing Study. Measures included Structured Clinical Interview for the DSM at recruitment in early pregnancy and comprehensive dietary intake questions, Edinburgh Postnatal Depression Scale, and self-report and recorded antidepressant use at third trimester and 6 and 12 months postpartum. RESULTS This study found that those women with untreated, current depression in pregnancy had higher unhealthy takeaway food intake across the perinatal period compared to those taking antidepressant medication or healthy control women, albeit the overall effects were small and the clinical significance unknown. Higher depressive symptoms in the postpartum were also associated with higher takeaway intake. There was no difference in fruit and vegetable intake between the three groups and intake was highest for all women late in pregnancy and declined in the postpartum period. In all, women's takeaway food intake increased from pregnancy across the postpartum. LIMITATIONS Lack of information on pre-pregnancy diet. CONCLUSIONS Unhealthy takeaway intake was found to be associated with depression; however, for those women who took antidepressant treatment, their diet patterns were similar to healthy controls. Future research should examine the relationship of treatments for depression in addition to depression and associated dietary behaviours.
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Affiliation(s)
- Megan Galbally
- College of Science, Health, Education and Engineering, Murdoch University, Murdoch, Australia; School of Medicine, University of Notre Dame, Fremantle, Australia; King Edward Memorial Hospital, Subiaco, Australia.
| | - Stuart J Watson
- College of Science, Health, Education and Engineering, Murdoch University, Murdoch, Australia; School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Philip Boyce
- Westmead Clinical School, Sydney Medical School, University of Sydney, Sydney, Australia
| | - Rebecca Anglin
- School of Medicine, University of Notre Dame, Fremantle, Australia; Fiona Stanley Hospital, Perth, Australia
| | | | - Andrew J Lewis
- College of Science, Health, Education and Engineering, Murdoch University, Murdoch, Australia
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12
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Piotrowski MC, Lunsford J, Gaynes BN. Lifestyle psychiatry for depression and anxiety: Beyond diet and exercise. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.21] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Madison C. Piotrowski
- Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Julia Lunsford
- Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill North Carolina
| | - Bradley N. Gaynes
- Department of Psychiatry University of North Carolina at Chapel Hill Chapel Hill North Carolina
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Aguilar-Latorre A, Navarro C, Oliván-Blázquez B, Gervilla E, Magallón Botaya R, Calafat-Villalonga C, García-Toro M, Boira S, Serrano-Ripoll MJ. Effectiveness and cost-effectiveness of a lifestyle modification programme in the prevention and treatment of subclinical, mild and moderate depression in primary care: a randomised clinical trial protocol. BMJ Open 2020; 10:e038457. [PMID: 33372070 PMCID: PMC7772323 DOI: 10.1136/bmjopen-2020-038457] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Major depression is a highly prevalent pathology that is currently the second most common cause of disease-induced disability in our society. The onset and continuation of depression may be related to a wide variety of biological and psychosocial factors, many of which are linked to different lifestyle aspects. Therefore, health systems must design and implement health promotion and lifestyle modification programmes (LMPs), taking into account personal factors and facilitators. The main objective of this protocol is to analyse the clinical effectiveness, cost-effectiveness and cost utility of an LMP and an LMP with information and communication technologies (ICTs) as adjunctive treatment for depression in primary care patients. The secondary objectives are to analyse the clinical effectiveness in the subgroup that presents comorbidity and to analyse the correlation between personal factors on health behaviour and lifestyle patterns. METHODS AND ANALYSIS A randomised, multicenter pragmatic clinical trial with three parallel groups consisting of primary healthcare patients suffering from subclinical, mild or moderate depression. The following interventions will be used: (1) Usual antidepressant treatment with psychological advice and/or psychotropic drugs prescribed by the general practitioner (treatment as usual (TAU)). (2) TAU+LMP. A programme to be imparted in six weekly 90-minute group sessions, intended to improve the following aspects: behavioural activation+daily physical activity+adherence to the Mediterranean diet pattern+sleep hygiene+careful exposure to sunlight. (3) TAU+LMP+ICTs: healthy lifestyle recommendations (TAU+LMP)+monitoring using ICTs (a wearable smartwatch). The primary outcome will be the depressive symptomatology and the secondary outcomes will be the quality of life, the use of health and social resources, personal factors on health behaviour, social support, lifestyle patterns and chronic comorbid pathology. Data will be collected before and after the intervention, with 6-month and 12-month follow-ups. ETHICS AND DISSEMINATION This study has been approved by the Clinical Research Ethics Committee of Aragón (approval number: C.P.-C.I. PI18/286) and the Research Ethics Committee of the Balearic Islands (IB3950/19 PI). Data distribution will be anonymous. Results will be disseminated via conferences and papers published in peer-reviewed, open-access journals. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03951350).
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Affiliation(s)
- Alejandra Aguilar-Latorre
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
| | - Capilla Navarro
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Bárbara Oliván-Blázquez
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Elena Gervilla
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
- Statistic and psychometric procedures implemented in Health Sciences Research Group, Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
| | - Rosa Magallón Botaya
- Primary Health Care Research Group of Aragón (GAIAP), Institute for Health Research Aragón (IIS Aragón), Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
| | | | - Mauro García-Toro
- Mental disorders of high prevalence Research Group (TRAMAP), Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
- Department of Medicine, University of the Balearic Islands, Palma de Mallorca, Spain
| | - Santiago Boira
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - María Jesús Serrano-Ripoll
- Department of Psychology, University of the Balearic Islands, Palma de Mallorca, Spain
- Research in Preventive Activities and Promotion and in Cancer Illes Balears (GRAPP-CAIB), Balearic Islands Health Research Institute (IdISBa), Palma de Mallorca, Spain
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Multiple lifestyle factors and depressed mood: a cross-sectional and longitudinal analysis of the UK Biobank (N = 84,860). BMC Med 2020; 18:354. [PMID: 33176802 PMCID: PMC7661271 DOI: 10.1186/s12916-020-01813-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/11/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND There is now evolving data exploring the relationship between depression and various individual lifestyle factors such as diet, physical activity, sleep, alcohol intake, and tobacco smoking. While this data is compelling, there is a paucity of longitudinal research examining how multiple lifestyle factors relate to depressed mood, and how these relations may differ in individuals with major depressive disorder (MDD) and those without a depressive disorder, as 'healthy controls' (HC). METHODS To this end, we assessed the relationships between 6 key lifestyle factors (measured via self-report) and depressed mood (measured via a relevant item from the Patient Health Questionnaire) in individuals with a history of or current MDD and healthy controls (HCs). Cross-sectional analyses were performed in the UK Biobank baseline sample, and longitudinal analyses were conducted in those who completed the Mental Health Follow-up. RESULTS Cross-sectional analysis of 84,860 participants showed that in both MDD and HCs, physical activity, healthy diet, and optimal sleep duration were associated with less frequency of depressed mood (all p < 0.001; ORs 0.62 to 0.94), whereas screen time and also tobacco smoking were associated with higher frequency of depressed mood (both p < 0.0001; ORs 1.09 to 1.36). In the longitudinal analysis, the lifestyle factors which were protective of depressed mood in both MDD and HCs were optimal sleep duration (MDD OR = 1.10; p < 0.001, HC OR = 1.08; p < 0.001) and lower screen time (MDD OR = 0.71; p < 0.001, HC OR = 0.80; p < 0.001). There was also a significant interaction between healthy diet and MDD status (p = 0.024), while a better-quality diet was indicated to be protective of depressed mood in HCs (OR = 0.92; p = 0.045) but was not associated with depressed mood in the MDD sample. In a cross-sectional (OR = 0.91; p < 0.0001) analysis, higher frequency of alcohol consumption was surprisingly associated with reduced frequency of depressed mood in MDD, but not in HCs. CONCLUSIONS Our data suggest that several lifestyle factors are associated with depressed mood, and in particular, it calls into consideration habits involving increased screen time and a poor sleep and dietary pattern as being partly implicated in the germination or exacerbation of depressed mood.
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Navarro C, Yáñez AM, Garcia A, Seguí A, Gazquez F, Marino JA, Ibarra O, Serrano-Ripoll MJ, Gomez-Juanes R, Bennasar-Veny M, Salva J, Oliván B, Roca M, Gili M, Garcia-Toro M. Effectiveness of a healthy lifestyle promotion program as adjunctive teletherapy for treatment-resistant major depression during COVID 19 pandemic: A randomized clinical trial protocol. Medicine (Baltimore) 2020; 99:e22958. [PMID: 33157937 PMCID: PMC7647547 DOI: 10.1097/md.0000000000022958] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 09/29/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Treatment-resistant depression (TRD) has a high prevalence and can be exacerbated by poor physical health and economic hardships, which have become common stressors during the current COVID-19 pandemic. The therapeutic approaches used to treat these patients are not always available, may be not be accepted by some patients, and often require face-to-face interactions. OBJECTIVE The main aim of this study will be to evaluate the effectiveness of an Internet-based adjuvant lifestyle-based intervention for patients with TRD. METHODS This will be a parallel, randomized, and controlled clinical trial. A total of 180 patients with TRD will be randomly allocated (1:1:1) to 1 of 3 groups: treatment prescribed by the mental health team and written suggestions for lifestyle changes (placebo control group); treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week mindfulness-based cognitive therapy program (active control group); or treatment prescribed by the mental health team, written suggestions for lifestyle changes, and an 8-week lifestyle change promotion program (intervention group). We will perform this study during the COVID-19 pandemic, and will administer interventions by teletherapy, and contact participants by telephone calls, text messages, and/or teleconferences. We will collect patient data using questionnaires administered at baseline, immediately after the intervention, and after 6 and 12 months. The primary outcome will be score on the Beck Depression Inventory-II. The secondary outcomes will be score on the Clinical Global Impressions Scale (used to quantify and track patient progress and treatment response over time) and health-related quality of life measured using the European Quality of Life-5 Dimensions Questionnaire. DISCUSSION Patients with TRD are especially vulnerable when face-to-face psychotherapy is unavailable. The main strength of the proposed study is the novelty of the intervention to be used as an adjuvant therapy. Our results may provide guidance for treatment of patients with TRD in future situations that require lockdown measures. CLINICALTRIALS REGISTRATION NUMBER NCT04428099.
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Affiliation(s)
| | - Aina M. Yáñez
- Department of Nursing and Physiotherapy and Research Group on Global Health and Human Development
| | - Aurora Garcia
- Research Institute of Health Sciences (IUNICS-IDISBA)
| | - Andrea Seguí
- Research Institute of Health Sciences (IUNICS-IDISBA)
| | | | | | - Olga Ibarra
- Research Institute of Health Sciences (IUNICS-IDISBA)
| | - Maria J. Serrano-Ripoll
- Primary Care Research Unit of Majorca, Balearic Islands Health Services and Department of Psychology, University of the Balearic Islands, Palma
| | | | - Miquel Bennasar-Veny
- Department of Nursing and Physiotherapy and Research Group on Global Health and Human Development
| | - Joan Salva
- Research Institute of Health Sciences (IUNICS-IDISBA)
| | - Bárbara Oliván
- Department of Psychology and Sociology, University of Zaragoza and Preventive Activities and Health Promotion Network, REDIAPP (G06/170), Zaragoza, Spain
| | - Miquel Roca
- Research Institute of Health Sciences (IUNICS-IDISBA)
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van Lee L, Chia A, Phua D, Colega M, Padmapriya N, Bernard JY, Cai S, Tham EKH, Teoh OH, Goh D, Gooley JJ, Gluckman PD, Yap F, Shek LPC, Godfrey KM, Tan KH, Chong YS, Müller-Riemenschneider F, Broekman B, Meaney M, Chen H, Chong MFF. Multiple modifiable lifestyle factors and the risk of perinatal depression during pregnancy: Findings from the GUSTO cohort. Compr Psychiatry 2020; 103:152210. [PMID: 33045668 DOI: 10.1016/j.comppsych.2020.152210] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 09/24/2020] [Accepted: 09/24/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Studies have identified lifestyle risk factors for perinatal depression, but none have examined the cumulative effect of these risk factors in pregnant women. METHODS We considered the following six factors during pregnancy: poor diet quality (Healthy eating index for Singapore pregnant women<median), poor sleep quality (global Pittsburgh sleep quality index score > 5), physical inactivity (<600 MET-minutes/week), vitamin D insufficiency (<50 nmol/l), smoking before or during pregnancy, and the perceived need for social support. Probable depression was assessed using the Edinburgh postnatal depression scale during pregnancy (>15) and at three months postpartum (≥13). Prevalence risk ratios were calculated with Poisson regressions while adjusting for potential confounders. RESULTS Of 535 pregnant women, 207 (39%) had zero or one risk factor, 146 (27%) had two, 119 (22%) had three, 48 (9%) had four, and 15 (3%) had ≥5 risk factors at 26-28 weeks' gestation. These six lifestyle habits contributed to 32% of the variance in depressive symptoms during pregnancy. The prevalence of being probably depressed was 6.4 (95% CI 2.1, 19.8; ptrend < 0.001) for expecting women who had ≥4 risk factors compared to women who had ≤1 risk factor. No association was observed between the number of risk factors and depressive symptoms at 3 months postpartum (ptrend = 0.746). CONCLUSION Pregnant women with ≥4 lifestyle risk factors showed a higher prevalence of depression during pregnancy, while no associations were observed for postpartum depression. CLINICAL TRIAL REGISTRATION This cohort is registered under the Clinical Trials identifier NCT01174875; http://www.clinicaltrials.gov/ct2/show/NCT01174875?term=GUSTO&rank=2.
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Affiliation(s)
- Linde van Lee
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Airu Chia
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Desiree Phua
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Marjorelee Colega
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Natarajan Padmapriya
- Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jonathan Y Bernard
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Early Life Research On Later Health Unit, Centre for Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), National Institute of Health and Medical Research (Inserm), Villejuif, France
| | - Shirong Cai
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Elaine K H Tham
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore
| | - Oon Hoe Teoh
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore
| | - Daniel Goh
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Joshua J Gooley
- Center for Cognitive Neuroscience, Program in Neuroscience and behavioural disorders, Duke-NUS Medical School, Singapore
| | - Peter D Gluckman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Fabian Yap
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore; Duke-NUS Medical School, Singapore, Singapore; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Lynette P C Shek
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Keith M Godfrey
- MRC Lifecourse Epidemiology Unit and NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Kok Hian Tan
- Duke-NUS Medical School, Singapore, Singapore; Department of Maternal Fetal Medicine, KK Women's and Children's Hospital, Singapore
| | - Yap-Seng Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Obstetrics and Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Falk Müller-Riemenschneider
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Institute for Social Medicine, Epidemiology and Health Economics, Charite University Medical Centre, Berlin, Germany
| | - Birit Broekman
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Department of Psychiatry, Amsterdam UMC, location VUmc, VU University, Amsterdam, the Netherlands; Department of Psychiatry, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Michael Meaney
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Departments of Psychiatry and Neurology and Neurosurgery, McGill University, Montreal, Canada
| | - Helen Chen
- Department of Psychological Medicine, KK Women's and Children's hospital, Singapore
| | - Mary F F Chong
- Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Clinical Nutrition Research Centre, Agency for Science, Technology and Research, Singapore.
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17
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Ren Z, Wang Q, Xiong W, Fan X, Guo X, Ma J, He M, Shen Y, Zhou G, Gong P, Liu M, Yang X, Liu H, Zhang X. Association between lifestyle factors and depressive symptoms among Chinese middle school students: a cross-sectional study. PSYCHOL HEALTH MED 2020; 26:1266-1273. [PMID: 32955356 DOI: 10.1080/13548506.2020.1823441] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
This study aimed to identify the independent contributions of lifestyle factors to depressive symptoms among Chinese middle school students, with a focus on gender differences. A cross-sectional study of 3081 middle school students was conducted in Ganzhou City, Jiangxi Province, China. Students were asked to complete a questionnaire including socio-demographics, lifestyle factors, the Pittsburgh Sleep Quality Index and the Chinese Secondary School Students Depression Scale. The total prevalence of depressive symptoms was 19.9%. Poor quality of sleep, smoking, drinking and longer mobile phone use time were related to increased prevalence of depressive symptoms after adjusting for potential confounders. A significant interaction between gender and quality of sleep on the depressive symptoms was found (P = 0.014). The gender-stratified analysis showed that quality of sleep was significantly associated with depressive symptoms in both genders. However, the effect in males was greater than that in females.
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Affiliation(s)
- Zheng Ren
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Qi Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Wenjing Xiong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xinwen Fan
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xia Guo
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Juan Ma
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Minfu He
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Yue Shen
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China.,Department of Party and Mass Personnel, China Population Communication Centre, Beijing, China
| | - Ge Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Ping Gong
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Meitian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xiaodi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Hongjian Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin, China
| | - Xiumin Zhang
- Department of Social Medicine and Health Management, School of Public Health, Jilin University, Changchun, Jilin, China
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Sousa KTD, Marques ES, Levy RB, Azeredo CM. Food consumption and depression among Brazilian adults: results from the Brazilian National Health Survey, 2013. CAD SAUDE PUBLICA 2020; 36:e00245818. [DOI: 10.1590/0102-311x00245818] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 07/08/2019] [Indexed: 12/20/2022] Open
Abstract
Abstract: Our study aimed to evaluate the association between food consumption and depression. We used data from the Brazilian National Health Survey; a cross-sectional study carried out in 2013 among 46,785 Brazilian adults. The exposures were regular consumption (≥ 5 times/week) of the markers of healthy (beans, vegetables, fruits, and natural fruit juices) and unhealthy food (sugar sweetened beverages; sweets and the substitution of lunch or dinner for snacks); and a nutritional score elaborated by combining the frequency of consumption of markers of healthy and unhealthy food, the higher the value, the better the diet. The outcome was depression, assessed through the PHQ-9 questionnaire answered by the participants. Those with PHQ-9 scores greater than or equal to 10 were classified as presenting depression. We performed logistic regression models adjusted for potential confounders. Regular consumption of sweets (OR = 1.53; 95%CI: 1.33-1.76) and regular replacement of meals for snacks (OR = 1.52; 95%CI: 1.21-1.90) were positively associated with depression. Regular consumption of sugar sweetened beverages was positively associated with depression among women (OR = 1.27; 95%CI: 1.10-1.48). Regular consumption of beans was negatively associated with depression (OR = 0.74; 95%CI: 0.65-0.84), consistent for both sexes. Comparing the top quintile of the nutritional score (healthier diet) to the bottom quintile (less healthy) we found a negative association with depression (OR = 0.63; 95%CI: 0.52-0.75). Our results add evidence on a possible role of food consumption in depression; future longitudinal studies should explore the mechanisms of these associations.
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Sebastianski M, Gates M, Gates A, Nuspl M, Bialy LM, Featherstone RM, Breault L, Mason-Lai P, Hartling L. Evidence available for patient-identified priorities in depression research: results of 11 rapid responses. BMJ Open 2019; 9:e026847. [PMID: 31256024 PMCID: PMC6609077 DOI: 10.1136/bmjopen-2018-026847] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/07/2019] [Accepted: 06/11/2019] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES Patient priority setting projects (PPSPs) can reduce research agenda bias. A key element of PPSPs is a review of available literature to determine if the proposed research priorities have been addressed, identify research gaps, recognise opportunities for knowledge translation (KT) and avoid duplication of research efforts. We conducted rapid responses for 11 patient-identified priorities in depression to provide a map of the existing evidence. DESIGN Eleven rapid responses. DATA SOURCES Single electronic database (PubMed). ELIGIBILITY CRITERIA Each rapid response had unique eligibility criteria. For study designs, we used a stepwise inclusion process that started with systematic reviews (SRs) if available, then randomised controlled trials and observational studies as necessary. RESULTS For all but one of the rapid responses we identified existing SRs (median 7 SRs per rapid response, range 0-179). There were questions where extensive evidence exists (ie, hundreds of primary studies), yet uncertainties remain. For example, there is evidence supporting the effectiveness of many non-pharmacological interventions (including psychological interventions and exercise) to reduce depressive symptoms. However, targeted research is needed that addresses comparative effectiveness of promising interventions, specific populations of interest (eg, children, minority groups) and adverse effects. CONCLUSIONS We identified an extensive body of evidence addressing patient priorities in depression and mapped the results and limitations of existing evidence, areas of uncertainty and general directions for future research. This work can serve as a solid foundation to guide future research in depression and KT activities. Integrated knowledge syntheses bring value to the PPSP process; however, the role of knowledge synthesis in PPSPs and methodological approaches are not well defined at present.
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Affiliation(s)
- Meghan Sebastianski
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Allison Gates
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Megan Nuspl
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Liza M Bialy
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Robin M Featherstone
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Lorraine Breault
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Ping Mason-Lai
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Patient Engagement Platform, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Alberta Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit Knowledge Translation Platform, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Gerber M, Beck J, Brand S, Cody R, Donath L, Eckert A, Faude O, Fischer X, Hatzinger M, Holsboer-Trachsler E, Imboden C, Lang U, Mans S, Mikoteit T, Oswald A, Pühse U, Rey S, Schreiner AK, Schweinfurth N, Spitzer U, Zahner L. The impact of lifestyle Physical Activity Counselling in IN-PATients with major depressive disorders on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers: study protocol for a randomized controlled trial. Trials 2019; 20:367. [PMID: 31221205 PMCID: PMC6585067 DOI: 10.1186/s13063-019-3468-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 05/24/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is a widespread and burdensome psychiatric issue. Physical activity counselling may increase lifestyle physical activity and cardiorespiratory fitness in this specific and particularly vulnerable population, which often suffers from both mental and physical health problems. Therefore, this study will examine the impact of a lifestyle physical activity counselling intervention on physical activity, cardiorespiratory fitness, depression, and cardiovascular health risk markers among in-patients diagnosed with MDD compared to controls. Secondary purposes are to examine the acceptability and perceived usefulness of the intervention among these patients, to find out whether the effectiveness of the intervention is moderated by genetic factors, and to compare baseline values with an age- and gender-matched group of healthy controls. METHODS The study is designed as a multi-centric two-arm randomized clinical trial including an intervention group and a placebo control group, allocation concealment, single-blinding, and intention-to-treat analysis. Participants (N = 334) will be continuously recruited from four clinics specialized in the treatment of MDD. The intervention builds on a standardized, theory-based, low-cost lifestyle physical activity counselling programme, which was specifically designed for an in-patient rehabilitation setting. The placebo control condition consists of general instructions about health-enhancing physical activity. Data assessments will take place 2-3 weeks after admission to in-patient treatment (baseline), and 6 weeks (post) and 12 months (follow-up) after discharge from in-patient treatment. The primary outcome is objectively assessed physical activity at follow-up. DISCUSSION Because regular physical activity has proven to be an important predictor of long-term response and remission in patients with major depression, we believe that our planned study may lay important groundwork by showing how individually tailored lifestyle physical activity counselling can be integrated into given clinical structures. Improving physical activity may have important implications for tackling metabolic and cardiovascular disease and increasing mood and cognitive functioning in this at-risk population, hence limiting the future burden of multiple chronic conditions. Increased physical activity may also reduce the likelihood of future depressive episodes. By moving towards the primary prevention of chronic physical conditions, much can be done to enhance the quality and quantity of life of people with MDD. TRIAL REGISTRATION ISRCTN, ISRCTN10469580 . Registered on 3 September 2018.
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Affiliation(s)
| | | | - Serge Brand
- University of Basel, Basel, Switzerland
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
- Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
| | | | - Lars Donath
- German Sport University Cologne, Cologne, Germany
| | - Anne Eckert
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | | | | | | | | | | | - Undine Lang
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Sarah Mans
- Private Clinic Wyss, Münchenbuchsee, Switzerland
| | | | - Anja Oswald
- Psychiatric Clinic Sonnenhalde, Riehen, Switzerland
| | - Uwe Pühse
- University of Basel, Basel, Switzerland
| | - Sofia Rey
- University of Basel, Basel, Switzerland
| | | | - Nina Schweinfurth
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
| | - Ursula Spitzer
- University of Basel, Adult Psychiatric Clinics (UPKE), Basel, Switzerland
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Taylor KL, Simpson S, Jelinek GA, Neate SL, De Livera AM, Brown CR, O'Kearney E, Marck CH, Weiland TJ. Longitudinal Associations of Modifiable Lifestyle Factors With Positive Depression-Screen Over 2.5-Years in an International Cohort of People Living With Multiple Sclerosis. Front Psychiatry 2018; 9:526. [PMID: 30425659 PMCID: PMC6218592 DOI: 10.3389/fpsyt.2018.00526] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 10/04/2018] [Indexed: 12/24/2022] Open
Abstract
Background: Depression is common and has a significant impact on quality of life for many people with multiple sclerosis (MS). A preventive management approach via modification of lifestyle risk factors holds potential benefits. We examined the relationship between modifiable lifestyle factors and depression risk and the change in depression over 2.5 years. Methods: Sample recruited using online platforms. 2,224 (88.9%) at baseline and 1,309 (93.4%) at 2.5 years follow up completed the necessary survey data. Depression risk was measured by the Patient Health Questionnaire-2 (PHQ-2) at baseline and Patient Health Questionniare-9 (PHQ-9) at 2.5-years follow-up. Multivariable regression models assessed the relationships between lifestyle factors and depression risk, adjusted for sex, age, fatigue, disability, antidepressant medication use, and baseline depression score, as appropriate. Results: The prevalence of depression risk at 2.5-years follow-up in this cohort was 14.5% using the PHQ-2 and 21.7% using the PHQ-9. Moderate alcohol intake, being a non-smoker, diet quality, no meat or dairy intake, vitamin D supplementation, omega 3 supplement use, regular exercise, and meditation at baseline were associated with lower frequencies of positive depression-screen 2.5 years later. Moderate alcohol intake was associated with greater likelihood of becoming depression-free and a lower likelihood of becoming depressed at 2.5-years follow-up. Meditating at least once a week was associated with a decreased frequency of losing depression risk, against our expectation. After adjusting for potential confounders, smoking, diet, physical activity, and vitamin D and omega-3 supplementation were not associated with a change in risk for depression. Conclusion: In a large prospective cohort study of people with MS and depression, in line with the emerging treatment paradigm of early intervention, these results suggest a role for some lifestyle factors in depression risk. Further studies should endeavor to explore the impact of positive lifestyle change and improving depression in people living with MS.
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Affiliation(s)
- Keryn L. Taylor
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Department of Psychiatry and Psychosocial Cancer Care, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Steve Simpson
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - George A. Jelinek
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Sandra L. Neate
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Alysha M. De Livera
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Chelsea R. Brown
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Emily O'Kearney
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
| | - Claudia H. Marck
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Carlton, VIC, Australia
| | - Tracey J. Weiland
- Neuroepidemiology Unit, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia
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Beumeler L, Waarsenburg E, Booij S, Scheurink A, Hoenders H. Evaluation of a lifestyle intervention program in primary care on physical and mental health and quality of life of cancer survivors: A pilot study. Eur J Integr Med 2018. [DOI: 10.1016/j.eujim.2018.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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23
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Olivan-Blázquez B, Montero-Marin J, García-Toro M, Vicens-Pons E, Serrano-Ripoll MJ, Castro-Gracia A, Sarasa-Bosque MC, Mendive-Arbeloa JM, López-del-Hoyo Y, Garcia-Campayo J. Facilitators and barriers to modifying dietary and hygiene behaviours as adjuvant treatment in patients with depression in primary care: a qualitative study. BMC Psychiatry 2018; 18:205. [PMID: 29921245 PMCID: PMC6008925 DOI: 10.1186/s12888-018-1779-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 06/07/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Major depression is a highly prevalent condition. Its pathogenesis is related to a wide variety of biological and psychosocial factors and among these is factors related to lifestyle. Lifestyle-based interventions seem to be appropriate strategies as coadjutant treatment. The objective of this study is to explore and identify expectations and experiences of both patients and healthcare professionals that can point to the main barriers and facilitators with regard to the promotion of healthy dietary and hygiene behaviours in patients suffering from major depression. METHODS A qualitative design was used to collect information from a wide range of purposefully and theoretically guided samples of depressed patients and health professionals from Primary Care (PC). Both in-depth interviews and discussion groups were used. A standardized protocol was designed to guide the interviews and groups, including the preparation of a topic list to be addressed, with previously tested, open suggestions that could be of interest. A thematic analysis was performed from grounded theory in order to explore, develop and define until saturation the emergent categories of analysis derived from the individual interview and group data. RESULTS Both patients as well as PC professionals noted a series of central aspects with respect to the implementation of a programme for the acquisition of healthy dietary and hygiene habits for depressive patients, which may be organized around 'personal', 'programmatic', and 'transversal' aspects. As for the personal aspects, categories regarding 'patient history', and 'disposition' were found; the programmatic aspects included categories such as 'presentation and monitoring', and modification of 'cognitive' and 'behavioural' habits; whereas the transversal aspects comprised the possibilities of 'social support' and defining categories of 'objectives'. CONCLUSION The implementation of intervention programmes that combine dietary and hygiene-related factors in patients with depression is complex, given the nature of the disorder itself, and its symptoms such as apathy and feelings of guilt or incompetence. Key issues exist for the success of the intervention, such as the simplicity of guidelines, tailoring through motivational interviewing, prolonged and intense monitoring throughout the different stages of the disorder, and the provision of adequate feedback and social support. PC could be an appropriate level in which to implement these interventions.
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Affiliation(s)
- B. Olivan-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Montero-Marin
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - M. García-Toro
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - E. Vicens-Pons
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Departamento de Psiquiatría, Parc Sanitari San Joan de Déu, Sant Boi de Llobregat, Spain
| | - M. J. Serrano-Ripoll
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | - A. Castro-Gracia
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS), Universitat de les Illes Balears (UIB), Palma de Mallorca, Spain
| | | | | | - Y. López-del-Hoyo
- Department of Psychology and Sociology, University of Zaragoza, Violante de Hungria 23, 50009 Zaragoza, Spain
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
| | - J. Garcia-Campayo
- Research Network on Preventive Activities and Health Promotion (Red de Investigación en Actividades Preventivas y Promoción de la Salud - RedIAPP), Barcelona, Spain
- Promosam Network, Red de Excelencia PSI2014-56303-REDT PROMOSAM: (Investigación en procesos, mecanismos y tratamientos psicológicos para la promoción de la salud mental), Economy and Competitiveness Ministry, Madrid, Spain
- Aragones Health Service, Zaragoza, Spain
- Department of Medicine and Psychiatry, University of Zaragoza, Zaragoza, Spain
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24
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Masana MF, Haro JM, Mariolis A, Piscopo S, Valacchi G, Bountziouka V, Anastasiou F, Zeimbekis A, Tyrovola D, Gotsis E, Metallinos G, Polystipioti A, Tur JA, Matalas AL, Lionis C, Polychronopoulos E, Sidossis LS, Tyrovolas S, Panagiotakos DB. Mediterranean diet and depression among older individuals: The multinational MEDIS study. Exp Gerontol 2018; 110:67-72. [PMID: 29775747 DOI: 10.1016/j.exger.2018.05.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 05/11/2018] [Accepted: 05/14/2018] [Indexed: 10/16/2022]
Abstract
BACKGROUND Depression has been linked to a large and growing economic and societal burden worldwide. In Europe, depression is one of the most frequent mental disorders across all age groups, but particularly in people aged 65 years and over, and higher depressive symptoms have been reported among individuals with chronic diseases (e.g., diabetes and heart disease). AIM To evaluate the role of adherence to the Mediterranean diet (MedDiet) in depression in a sample of older people living in the Mediterranean basin. METHODS Standard procedures were used to determine socio-demographic, lifestyle, and clinical characteristics of the participants, as well as their dietary habits, and depressive symptoms were evaluated using the Geriatric Depression Scale (GDS). Multi-adjusted logistic and linear regression analyses were carried out to evaluate the associations between participants' characteristics and depression. RESULTS Participants classified as having mild or severe depression were less educated and physically active, and more diabetic, and they reported less adherence to the MedDiet. Adherence to the MedDiet was associated with the absence of depression [(OR, 95% CI): 0.65, 0.50-0.85]. In addition, daily tea drinking was also related to the absence of depression [(OR, 95% CI): 0.51, 0.40-0.65]. CONCLUSIONS Greater adherence to the MedDiet and daily tea drinking seem to have a beneficial effect on depressive symptoms in older adults.
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Affiliation(s)
- Maria F Masana
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain; Facultat de Medicina, Universitat de Barcelona, Casanova, 143, 08036 Barcelona, Spain
| | - Josep Maria Haro
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain
| | - Anargiros Mariolis
- Health Center of Areopolis, General Hospital of Sparta, Areopolis, Greece
| | - Suzanne Piscopo
- University of Malta, Nutrition, Family and Consumer Studies Office, Msida, Malta
| | - Giuseppe Valacchi
- Department of Life Sciences and Biotechnology, University of Ferrara, Ferrara, Italy
| | - Vassiliki Bountziouka
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Foteini Anastasiou
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Akis Zeimbekis
- Health Center of Kalloni, General Hospital of Mitilini, Mitilini, Greece
| | - Dimitra Tyrovola
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Efthimios Gotsis
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - George Metallinos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Anna Polystipioti
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Josep-Antoni Tur
- Research Group on Community Nutrition and Oxidative Stress, Universitat de les Illes Balears & CIBERobn, Guillem Colom Bldg, Campus, E-07122 Palma de Mallorca, Spain
| | - Antonia-Leda Matalas
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece
| | - Evangelos Polychronopoulos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Labros S Sidossis
- Department of Exercise Science and Sport Studies, School of Arts and Sciences, Rutgers University, NJ, USA
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Dr Antoni Pujades, 42, 08830, Sant Boi de Llobregat, Barcelona, Spain; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Monforte de Lemos 3-5, Pabellón 11, 28029 Madrid, Spain; Visiting Fellow at Institute for Health Metrics and Evaluation, University of Washington, 2301 Fifth Avenue, mSuite 600, Seattle, WA 98121, USA
| | - Demosthenes B Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece.
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Xu Y, Qi J, Yang Y, Wen X. The contribution of lifestyle factors to depressive symptoms: A cross-sectional study in Chinese college students. Psychiatry Res 2016; 245:243-249. [PMID: 27565695 DOI: 10.1016/j.psychres.2016.03.009] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 12/09/2015] [Accepted: 03/04/2016] [Indexed: 12/17/2022]
Abstract
It is well known that some lifestyle factors are related to depression, but their cumulative contribution to the depression remains unclear. This study aimed to assess the importance of multiple lifestyle factors in contributing to depressive symptoms among Chinese college students. Between September and December in 2012, we conducted a cross-sectional study among 1907 Chinese college students from Guangzhou, Southern China. College students completed self-administered questionnaires and reported their lifestyle factors including sleep quality and duration, Internet use, smoking, drinking, exercise, outdoor activity or sunlight exposure, and eating breakfast. Depression was measured using the Center for Epidemiologic Studies Depression Scale (CES-D), and mild-to-moderate depressive symptoms were defined as the CES-D score ≥16. Among all the students, 29.7% reported mild-to-moderate depressive symptoms. Higher quality and longer duration of sleep, more exercises, more outdoor activities or sunlight exposures, and eating breakfast daily were associated with a lower CES-D score, which could explain 11.3% of variance of the CES-D score, after adjusting for socio-demographics, family history, interpersonal relationship, and academic characteristics using hierarchical multivariable linear regression. These associations were comparable between males and females. The protective role of healthy lifestyles should be considered in intervention programs for improving mental health among college students.
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Affiliation(s)
- Ying Xu
- Department of Non-communicable Chronic Disease Prevention and Control, Baoan Chronic Diseases Prevent and Cure Hospital, Baoan District, Shenzhen, Guangdong Province, China; Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Juan Qi
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China
| | - Yi Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
| | - Xiaozhong Wen
- Division of Behavioral Medicine, Department of Pediatrics, School of Medicine and Biomedical Sciences, State University of New York at Buffalo, 3435 Main St., G56 Farber Hall, Buffalo, NY 14214-3000, USA.
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Kvam S, Kleppe CL, Nordhus IH, Hovland A. Exercise as a treatment for depression: A meta-analysis. J Affect Disord 2016; 202:67-86. [PMID: 27253219 DOI: 10.1016/j.jad.2016.03.063] [Citation(s) in RCA: 505] [Impact Index Per Article: 56.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 02/29/2016] [Accepted: 03/12/2016] [Indexed: 01/14/2023]
Abstract
BACKGROUND This meta-analysis of randomized controlled trials (RCTs) examines the efficacy of physical exercise as treatment for unipolar depression, both as an independent intervention and as an adjunct intervention to antidepressant medication. METHODS We searched PsycINFO, EMBASE, MEDLINE, CENTRAL, and Sports Discus for articles published until November 2014. Effect sizes were computed with random effects models. The main outcome was reduction in depressive symptoms or remission. RESULTS A total of 23 RCTs and 977 participants were included. Physical exercise had a moderate to large significant effect on depression compared to control conditions (g=-0.68), but the effect was small and not significant at follow-up (g=-0.22). Exercise compared to no intervention yielded a large and significant effect size (g=-1.24), and exercise had a moderate and significant effect compared to usual care (g=-0.48). The effects of exercise when compared to psychological treatments or antidepressant medication were small and not significant (g=-0.22 and g=-0.08, respectively). Exercise as an adjunct to antidepressant medication yielded a moderate effect (g=-0.50) that trended toward significance. LIMITATIONS Use of the arms with the largest clinical effect instead of largest dose may have overestimated the effect of exercise. CONCLUSIONS Physical exercise is an effective intervention for depression. It also could be a viable adjunct treatment in combination with antidepressants.
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Affiliation(s)
- Siri Kvam
- Sogndal Child and Adolescent Psychiatric Outpatient Clinic, Division of Medicine, District General Hospital of Førde, postboks 1000, 6807 Førde, Norway.
| | | | | | - Anders Hovland
- Department of Clinical Psychology, University of Bergen, Norway; Solli District Psychiatric Centre (DPS), Norway
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The impact of whole-of-diet interventions on depression and anxiety: a systematic review of randomised controlled trials. Public Health Nutr 2015; 18:2074-93. [DOI: 10.1017/s1368980014002614] [Citation(s) in RCA: 134] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AbstractObjectiveNon-pharmacological approaches to the treatment of depression and anxiety are of increasing importance, with emerging evidence supporting a role for lifestyle factors in the development of these disorders. Observational evidence supports a relationship between habitual diet quality and depression. Less is known about the causative effects of diet on mental health outcomes. Therefore a systematic review was undertaken of randomised controlled trials of dietary interventions that used depression and/or anxiety outcomes and sought to identify characteristics of programme success.DesignA systematic search of the Cochrane, MEDLINE, EMBASE, CINAHL, PubMed and PyscInfo databases was conducted for articles published between April 1971 and May 2014.ResultsOf the 1274 articles identified, seventeen met eligibility criteria and were included. All reported depression outcomes and ten reported anxiety or total mood disturbance. Compared with a control condition, almost half (47 %) of the studies observed significant effects on depression scores in favour of the treatment group. The remaining studies reported a null effect. Effective dietary interventions were based on a single delivery mode, employed a dietitian and were less likely to recommend reducing red meat intake, select leaner meat products or follow a low-cholesterol diet.ConclusionsAlthough there was a high level of heterogeneity, we found some evidence for dietary interventions improving depression outcomes. However, as only one trial specifically investigated the impact of a dietary intervention in individuals with clinical depression, appropriately powered trials that examine the effects of dietary improvement on mental health outcomes in those with clinical disorders are required.
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Sarris J, Nishi D, Xiang YT, Su KP, Bannatyne A, Oliver G, Kua EH, Ng CH. Implementation of psychiatric-focused lifestyle medicine programs in Asia. Asia Pac Psychiatry 2015; 7:345-54. [PMID: 26403310 DOI: 10.1111/appy.12212] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 08/23/2015] [Indexed: 12/11/2022]
Abstract
Lifestyle-focused health programs are growing in interest throughout Western society, and a range of lifestyle factors are known to enhance both physical and mental health. However, it remains largely unknown as to whether this approach is salient for the Asian context. The major components of integrative lifestyle-focused health programs to enhance mental and physical health are considered to include the evidence-based adoption of physical activity and exercise, dietary modification, general psychoeducation, adequate relaxation/sleep and social interaction, use of mindfulness techniques, the reduction of substance use, attention of intersecting environmental factors, and the potential use of motivation and goal-setting techniques. This paper outlines an overview of the evidence underpinning these elements, and discusses potential barriers and challenges, and what logistical considerations may need to be addressed in the implementation of such programs within the context of Asian cultures.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia.,Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Daisuke Nishi
- Department of Mental Health Policy and Evaluation, National Institute of Mental Health, National Center of Neurology and Psychiatry, Kodaira, Tokyo, Japan
| | - Yu-Tao Xiang
- Unit of Psychiatry, Faculty of Health Sciences, University of Macau, Macao SAR, China
| | - Kuan-Pin Su
- Department of Psychiatry & Mind-Body Interface Laboratory (MBI-Lab), China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Neural and Cognitive Sciences, China Medical University, Taichung, Taiwan
| | - Amy Bannatyne
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Georgina Oliver
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ee-Heok Kua
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Hong Ng
- Department of Psychiatry, The Melbourne Clinic, The University of Melbourne, Melbourne, Victoria, Australia
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Serrano Ripoll MJ, Oliván-Blázquez B, Vicens-Pons E, Roca M, Gili M, Leiva A, García-Campayo J, Demarzo MP, García-Toro M. Lifestyle change recommendations in major depression: Do they work? J Affect Disord 2015; 183:221-8. [PMID: 26025368 DOI: 10.1016/j.jad.2015.04.059] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/29/2015] [Accepted: 04/30/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Modifying some lifestyle factors can be useful in depression, at least as an adjuvant treatment. Combining different lifestyle interventions seems to be an adequate strategy to increase their antidepressant efficacy according with preliminary studies, but this issue has not been enough investigated. METHODS The present study is a randomized, double-blinded, multicentre, two arm-parallel clinical trials, with a 12 month follow-up. The sample consisted of 273 Primary Care patients. Four combined hygienic-dietary written recommendations were given to the patients about diet, exercise, light exposure and sleep hygiene. RESULTS Both active and control interventions were associated with improvement on BDI (Beck Depression Inventory) scores. However, there were not statistically significant differences (7.0 vs. 7.6; p=0.594). LIMITATIONS We were unable to monitor whether patients carry out recommendations. Intervention could be too difficult to accomplish for depressed patients without enough support and supervision. CONCLUSIONS Just giving written lifestyle recommendations are not enough for depressive patients to benefit from them, so perhaps lifestyle change recommendations work or do not work on Depression depending on how they are presented to patients and on monitoring systems of their implementation.
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Affiliation(s)
- M J Serrano Ripoll
- University of Balearic Islands, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Palma, Spain
| | - B Oliván-Blázquez
- Department of Psychology and Sociology, University of Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, Spain
| | - E Vicens-Pons
- Primary Care Prevention and Health Promotion Research Network, Spain; Psychiatric Service, Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - M Roca
- University of Balearic Islands, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Palma, Spain; Primary Care Prevention and Health Promotion Research Network, Spain
| | - M Gili
- University of Balearic Islands, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Palma, Spain; Primary Care Prevention and Health Promotion Research Network, Spain
| | - A Leiva
- Primary Care Research Unit of Mallorca, Health Services-IbSalut, Instituto de Investigación Sanitaria, Spain
| | - J García-Campayo
- Department of Psychology and Sociology, University of Zaragoza, Spain; Primary Care Prevention and Health Promotion Research Network, Spain
| | - M P Demarzo
- "Mente Aberta" - Brazilian Center for Mindfulness and Health Promotion, Federal University of Sao Paulo, UNIFESP, Brazil
| | - M García-Toro
- University of Balearic Islands, Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), Palma, Spain; Primary Care Prevention and Health Promotion Research Network, Spain.
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Puterman E, Lin J, Krauss J, Blackburn EH, Epel ES. Determinants of telomere attrition over 1 year in healthy older women: stress and health behaviors matter. Mol Psychiatry 2015; 20:529-35. [PMID: 25070535 PMCID: PMC4310821 DOI: 10.1038/mp.2014.70] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/13/2014] [Accepted: 06/06/2014] [Indexed: 12/21/2022]
Abstract
Telomere length, a reliable predictor of disease pathogenesis, can be affected by genetics, chronic stress and health behaviors. Cross-sectionally, highly stressed postmenopausal women have shorter telomeres, but only if they are inactive. However, no studies have prospectively examined telomere length change over a short period, and if rate of attrition is affected by naturalistic factors such as stress and engagement in healthy behaviors, including diet, exercise, and sleep. Here we followed healthy women over 1 year to test if major stressors that occurred over the year predicted telomere shortening, and whether engaging in healthy behaviors during this period mitigates this effect. In 239 postmenopausal, non-smoking, disease-free women, accumulation of major life stressors across a 1-year period predicted telomere attrition over the same period-for every major life stressor that occurred during the year, there was a significantly greater decline in telomere length over the year of 35 bp (P<0.05). Yet, these effects were moderated by health behaviors (interaction B=0.19, P=0.04). Women who maintained relatively higher levels of health behaviors (1 s.d. above the mean) appeared to be protected when exposed to stress. This finding has implications for understanding malleability of telomere length, as well as expectations for possible intervention effects. This is the first study to identify predictors of telomere length change over the short period of a year.
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Affiliation(s)
- E Puterman
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - J Lin
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - J Krauss
- Division of Physical Medicine and Rehabilitation, Department of Orthopedic Surgery, Stanford University, Stanford, CA, USA
| | - E H Blackburn
- Department of Biochemistry and Biophysics, University of California, San Francisco, San Francisco, CA, USA
| | - E S Epel
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Taylor KL, Hadgkiss EJ, Jelinek GA, Weiland TJ, Pereira NG, Marck CH, van der Meer DM. Lifestyle factors, demographics and medications associated with depression risk in an international sample of people with multiple sclerosis. BMC Psychiatry 2014; 14:327. [PMID: 25467385 PMCID: PMC4263016 DOI: 10.1186/s12888-014-0327-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 11/10/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Depression is the most common co-morbidity for people with Multiple Sclerosis (MS); irrespective of disease severity, depression has the greatest impact on quality of life. An emerging paradigm in the treatment of depression is lifestyle medicine. There is significant potential to prevent and treat depression through modification of lifestyle risk factors for people with MS. This study sought to understand the association between lifestyle risk factors, medication and depression risk through the analysis of self-reported data from a large international sample of people with MS. METHODS This cross-sectional analysis recruited a total of 2459 participants via Web 2.0 platforms. Survey data included socio-demographics; a range of lifestyle risk factors; medication; disease variables and depression risk using the Patient Health Questionnaire-2 (PHQ-2). RESULTS In total approximately one fifth (19.3%) of our sample screened positive for depression (PHQ-2 score ≥3). Several demographic factors were significantly associated with this depression risk in bivariate analysis. Regression analyses showed that poor diet, low levels of exercise, obesity, smoking, marked social isolation and taking interferon were associated with greater depression risk. Participants who supplemented with omega 3s, particularly flaxseed oil, had frequent fish consumption, supplemented with vitamin D, meditated, and had moderate alcohol consumption had significantly reduced depression risk. CONCLUSIONS This study demonstrates a significant association between modifiable lifestyle factors and depression risk. Planned longitudinal follow up may clarify causality. Clinicians and people with MS should be aware of the wide range of modifiable lifestyle factors that may reduce depression risk as part of a comprehensive secondary and tertiary preventive medical approach to managing MS.
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Affiliation(s)
- Keryn L Taylor
- Department of Psychiatry, St Vincent's Hospital Melbourne, Victoria, VIC, 3065, Australia. .,Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Emily J Hadgkiss
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - George A Jelinek
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Tracey J Weiland
- Department of Medicine, The University of Melbourne St Vincent's Hospital, Melbourne, Victoria, Australia. .,Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Naresh G Pereira
- Faculty of Medicine, Notre Dame University, Fremantle, Western Australia, Australia.
| | - Claudia H Marck
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
| | - Dania M van der Meer
- Emergency Practice Innovation Centre, St Vincent's Hospital, Melbourne, Victoria, Australia.
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Knapen J, Vancampfort D, Moriën Y, Marchal Y. Exercise therapy improves both mental and physical health in patients with major depression. Disabil Rehabil 2014; 37:1490-5. [DOI: 10.3109/09638288.2014.972579] [Citation(s) in RCA: 193] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Garcia-Toro M, Gili M, Ibarra O, Monzón S, Vives M, Garcia-Campayo J, Gomez-Juanes R, Roca M. Metabolic syndrome improvement in depression six months after prescribing simple hygienic-dietary recommendations. BMC Res Notes 2014; 7:339. [PMID: 24899528 PMCID: PMC4055255 DOI: 10.1186/1756-0500-7-339] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Accepted: 06/02/2014] [Indexed: 12/23/2022] Open
Abstract
Background Changes in diet and exercise have been separately demonstrated to improve Depression, although scientific evidence available is scarce. In a previously published controlled study, just recommending these and other lifestyle measures (sleep restriction and sunlight exposure) in combination once, patients experienced improvements in their depressive symptoms six months later. In this sample, one in three depressive patients had metabolic syndrome (MetS) at baseline. First line treatment of MetS condition is hygienic-dietetic, being Mediterranean diet and exercise especially important. Therefore we analyzed if lifestyle recommendations also improved their metabolic profile. Findings During the sixth month evaluation, a smaller number of patients from the group receiving hygienic-dietary recommendations met MetS criteria comparing with the control group. Conclusions This study suggests that costless lifestyle recommendations, such as exercise and Mediterranean diet, have the capacity to promote both mental and physical health in a significant proportion of depressive patients. Further research is needed to confirm or discard these preliminary findings.
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Affiliation(s)
- Mauro Garcia-Toro
- Institut Universitari d'Investigació en Ciències de la Salut (IUNICS), University of Balearic Islands and Red de Investigación en Actividades Preventivas y Promoción de la Salud (RedIAPP), Palma, Spain.
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Sarris J, O’Neil A, Coulson CE, Schweitzer I, Berk M. Lifestyle medicine for depression. BMC Psychiatry 2014; 14:107. [PMID: 24721040 PMCID: PMC3998225 DOI: 10.1186/1471-244x-14-107] [Citation(s) in RCA: 250] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2013] [Accepted: 03/07/2014] [Indexed: 12/16/2022] Open
Abstract
The prevalence of depression appears to have increased over the past three decades. While this may be an artefact of diagnostic practices, it is likely that there are factors about modernity that are contributing to this rise. There is now compelling evidence that a range of lifestyle factors are involved in the pathogenesis of depression. Many of these factors can potentially be modified, yet they receive little consideration in the contemporary treatment of depression, where medication and psychological intervention remain the first line treatments. "Lifestyle Medicine" provides a nexus between public health promotion and clinical treatments, involving the application of environmental, behavioural, and psychological principles to enhance physical and mental wellbeing. This may also provide opportunities for general health promotion and potential prevention of depression. In this paper we provide a narrative discussion of the major components of Lifestyle Medicine, consisting of the evidence-based adoption of physical activity or exercise, dietary modification, adequate relaxation/sleep and social interaction, use of mindfulness-based meditation techniques, and the reduction of recreational substances such as nicotine, drugs, and alcohol. We also discuss other potential lifestyle factors that have a more nascent evidence base, such as environmental issues (e.g. urbanisation, and exposure to air, water, noise, and chemical pollution), and the increasing human interface with technology. Clinical considerations are also outlined. While data supports that some of these individual elements are modifiers of overall mental health, and in many cases depression, rigorous research needs to address the long-term application of Lifestyle Medicine for depression prevention and management. Critically, studies exploring lifestyle modification involving multiple lifestyle elements are needed. While the judicious use of medication and psychological techniques are still advocated, due to the complexity of human illness/wellbeing, the emerging evidence encourages a more integrative approach for depression, and an acknowledgment that lifestyle modification should be a routine part of treatment and preventative efforts.
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Affiliation(s)
- Jerome Sarris
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- Centre for Human Psychopharmacology, Swinburne University of Technology, Melbourne, Australia
| | - Adrienne O’Neil
- School of Medicine, Deakin University, Geelong, Australia
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Isaac Schweitzer
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
| | - Michael Berk
- Department of Psychiatry, The University of Melbourne, 2 Salisbury Street, Richmond 3121 Victoria, Australia
- School of Medicine, Deakin University, Geelong, Australia
- Florey Institute for Neuroscience and Mental Health, Parkville, Australia
- Orygen Youth Health Research Institute, Parkville, Australia
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Persistence of chronic major depression: a national prospective study. J Affect Disord 2013; 151:306-12. [PMID: 23866303 DOI: 10.1016/j.jad.2013.06.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/07/2013] [Accepted: 06/08/2013] [Indexed: 11/22/2022]
Abstract
BACKGROUND Chronic major depressive disorder (CMDD) is highly prevalent and associated with high personal and societal cost. Identifying risk factors for persistence and remission of CMDD may help in developing more effective treatment and prevention interventions. METHODS Prospective cohort study of individuals participating in the National Epidemiologic Survey on Alcohol and Related Conditions (Wave 1; n=43,093) and its 3-year follow-up (Wave 2; n=34,653) who met a diagnosis of CMDD at the Wave 1 assessment. RESULTS Among the 504 respondents who met criteria for present CMDD at Wave 1, only 63 (11.52%) of them continued to meet criteria of CMDD. A history of childhood sexual abuse, earlier onset of MDD, presence of comorbidity and a history of treatment-seeking for depression predicted persistence of CMDD three years after the baseline evaluation. LIMITATIONS Our sample is limited to adults, our follow-up period was only three-years and the diagnosis of CMDD at baseline was retrospective. CONCLUSIONS CMDD shows high rates of remission within three years of baseline assessment, although some specific risk factors predict a persistent course. Given the high personal and societal cost associated with CMDD, there is a need to develop and disseminate effective interventions for CMDD.
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Morgan AJ, Jorm AF, Mackinnon AJ. Self-Help for Depression via E-mail: A Randomised Controlled Trial of Effects on Depression and Self-Help Behaviour. PLoS One 2013; 8:e66537. [PMID: 23805231 PMCID: PMC3689826 DOI: 10.1371/journal.pone.0066537] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2013] [Accepted: 05/05/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Self-help or self-management strategies are commonly used to deal with depression, but not all are thought to be helpful. A previous study found that sub-threshold depression symptoms were improved by an e-mail intervention that encouraged the use of evidence-based self-help strategies. AIM To investigate whether these e-mails were effective for adults with a range of depression symptomatology including major depression. METHOD The study was a parallel-group randomised controlled trial. Adult participants with any level of depressive symptoms were recruited over the internet from the United Kingdom, Australia, Canada, Ireland, New Zealand and the United States. Participants were randomised to receive a series of e-mails either promoting the use of evidence-based self-help strategies or containing depression information as a control. E-mails were sent automatically twice a week for six weeks. Depression symptoms were assessed with the self-rated Patient Health Questionnaire depression scale (PHQ-9). RESULTS 1736 participants with a wide range of symptom severity were recruited and assigned to active (n = 862) and control (n = 874) groups. However, there was a significant attrition rate, with 66.9% lost to follow-up at post-intervention. Both groups showed large improvements in depression symptoms overall, with no significant difference in improvement at the end of the study (mean difference in improvement 0.35 points, 95% CI: -0.57 to 1.28, d = 0.11, 95% CI: -0.06 to 0.27), although there was a small effect at the study mid-point. Results were similar for the sub-group of participants with major depression. The active group showed small to moderate improvements in self-help behaviour (d = 0.40, 95% CI: 0.23 to 0.56). CONCLUSIONS These results suggest that the e-mails were able to increase participants' use of evidence-based self-help, but that this did not improve depression more than an attention control. CLINICALTRIALSGOV NCT01399502.
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Affiliation(s)
- Amy J. Morgan
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Anthony F. Jorm
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Andrew J. Mackinnon
- Orygen Youth Health Research Centre, Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia
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Lopresti AL, Hood SD, Drummond PD. A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. J Affect Disord 2013; 148:12-27. [PMID: 23415826 DOI: 10.1016/j.jad.2013.01.014] [Citation(s) in RCA: 418] [Impact Index Per Article: 34.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/16/2013] [Accepted: 01/17/2013] [Indexed: 12/15/2022]
Abstract
Research on major depression has confirmed that it is caused by an array of biopsychosocial and lifestyle factors. Diet, exercise and sleep are three such influences that play a significant mediating role in the development, progression and treatment of this condition. This review summarises animal- and human-based studies on the relationship between these three lifestyle factors and major depressive disorder, and their influence on dysregulated pathways associated with depression: namely neurotransmitter processes, immuno-inflammatory pathways, hypothalamic-pituitary-adrenal (HPA) axis disturbances, oxidative stress and antioxidant defence systems, neuroprogression, and mitochondrial disturbances. Increased attention in future clinical studies on the influence of diet, sleep and exercise on major depressive disorder and investigations of their effect on physiological processes will help to expand our understanding and treatment of major depressive disorder. Mental health interventions, taking into account the bidirectional relationship between these lifestyle factors and major depression are also likely to enhance the efficacy of interventions associated with this disorder.
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Affiliation(s)
- Adrian L Lopresti
- School of Psychology, Murdoch University, Perth, Western Australia 6150, Australia.
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Sanchez-Villegas A, Martínez-González MA. Diet, a new target to prevent depression? BMC Med 2013; 11:3. [PMID: 23286788 PMCID: PMC3570363 DOI: 10.1186/1741-7015-11-3] [Citation(s) in RCA: 104] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 01/03/2013] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Research on the role of diet in the prevention of depression is scarce. Some evidence suggests that depression shares common mechanisms with cardiovascular disease. DISCUSSION Before considering the role of diet in the prevention of depression, several points need to be considered. First, in general, evidence has been found for the effects of isolated nutrients or foods, and not for dietary patterns. Second, most previous studies have a cross-sectional design. Third, information is generally collected though questionnaires, increasing the risk of misclassification bias. Fourth, adequate control of confounding factors in observational studies is mandatory. SUMMARY Only a few cohort studies have analyzed the relationship between overall dietary patterns, such as the Mediterranean diet, and primary prevention of depression. They have found similar results to those obtained for the role of this dietary pattern in cardiovascular disease. To confirm the findings obtained in these initial cohort studies, we need further observational longitudinal studies with improved methodology, as well as large randomized primary prevention trials, with interventions based on changes in the overall food pattern, that include participants at high risk of mental disorders.
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Affiliation(s)
- Almudena Sanchez-Villegas
- Deparment of Clinical Sciences, University of Las Palmas de Gran Canaria, PO Box 550, CP 35080, Las Palmas de Gran Canaria, Spain.
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Garcia-Toro M, Roca M, Monzón S, Vives M, Oliván B, Vicens E, Salva J, Gili M. Hygienic-dietary recommendations for major depression treatment: study protocol of a randomized controlled trial. BMC Psychiatry 2012; 12:201. [PMID: 23158080 PMCID: PMC3528444 DOI: 10.1186/1471-244x-12-201] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 11/07/2012] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression is a highly prevalent and disabling mental disorder with an incidence rate which appears to be increasing in the developed world. This fact seems to be at least partially related to lifestyle factors. Some hygienic-dietary measures have shown their efficacy as a coadjuvant of standard treatment. However, their effectiveness has not yet been proved enough in usual clinical practice. METHODS Multicenter, randomized, controlled, two arm-parallel, clinical trial involving 300 patients over 18 years old with a diagnosis of Major Depression. Major depression will be diagnosed by means of the Mini-International Neuropsychiatric Interview. The Beck Depression Inventory total score at the end of the study will constitute the main efficacy outcome. Quality of Life and Social and Health Care Services Consumption Scales will be also administered. Patients will be assessed at three different occasions: baseline, 6-month follow-up and 12-month follow-up. DISCUSSION We expect the patients in the active lifestyle recommendations group to experience a greater improvement in their depressive symptoms and quality of life with lower socio-sanitary costs. TRIAL REGISTRATION ISRCTN73931675.
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Affiliation(s)
- Mauro Garcia-Toro
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
| | - Miquel Roca
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
| | - Saray Monzón
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
| | - Margalida Vives
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
| | - Bárbara Oliván
- Facultad de Ciencias de la Salud, Universidad de San Jorge, Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Zaragoza, Spain
| | - Enric Vicens
- Departamento de Psiquiatría, Parc Sanitari San Joan de Déu, Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Barcelona, Spain
| | - Joan Salva
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
- Departamento de Psiquiatría, Hospital Son Espases, Palma de Mallorca, Spain
| | - Margalida Gili
- Institut Universitari d’Investigació en Ciències de la Salut (IUNICS). Universitat de les Illes Balears (UIB). Red de Investigación en Actividades Preventivas y Promoción de la Salud (redIAPP), Palma de Mallorca, Spain
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